Federal investigation finds safety violations at The Acadia Hospital

Correction: A previous version of this story incorrectly referred to The Acadia Hospital as “for-profit.” It is a non-profit hospital and a member of the non-profit Eastern Maine Healthcare Systems, based in Brewer.

The investigation by the federal Occupational Health and Safety Administration also faulted the hospital for inadequately documenting work-related injuries and imposed a total fine of $11,700.

The OSHA investigation was triggered in July 2010 by an employee complaint of an unacceptable increase in patient assaults and staff injuries in the wake of a stringent “no restraints” policy imposed by Acadia CEO and president David Proffitt, who was hired in September 2008. Media reports of the investigation elicited a deluge of employee allegations, mostly anonymous, that Proffitt’s policies and management style not only have undermined employee safety and moral but also have jeopardized patient care at the private, non-profit hospital.

Proffitt, who ran into similar criticism in his previous post as superintendent of the state-owned Riverview Psychiatric Hospital in Augusta, has defended his restraints policy as keeping with national standards supported by federal mental health agencies, professional associations and advocacy groups. The Acadia Hospital board of directors has elected to stand by the CEO during the OSHA investigation, despite growing public concern about his leadership.

The OSHA report released Tuesday evening calls “serious” the violation of safe-workplace standards that has resulted in at least 115 on-the-job physical assaults against staff by violent psychiatric patients at the 100-bed hospital since January 2008. These incidents have resulted in approximately 1,741 restricted-duty days and about 570 “days away from work,” according to the report.

In addition, there were during the same period “at least 76 nonrecordable cases resulting in broken teeth, prescription glasses broken in physical assaults, contusions, human bites, being punched in the face, or being hit and kicked by violent psychiatric patients,” the report states.

The report documents several cases of “particular severity.”

On April 30, 2010, a psychiatrist was choked and beaten by a patient.

The next day, the same patient “choked, beat, pulled hair and pounded a nurse’s face into a wall.”

In July and August, clinical staff were “aggressively assaulted” by different patients, resulting in a severe kick to the groin of one worker and severe facial injuries in the other.

The report found that these injuries were the result, at least in part, of ineffective workplace safety standards that have failed to protect staff from violent patients. Without specifically calling for the expanded use of physical and mechanical restraints — which may include hands-on body holds as well as straps, vests and immobilizing bed nets — the report demands the implementation of “feasible and acceptable” means of abating the dangers posed to staff by out-of-control patients.

These measures include enhanced screening of patients for violent tendencies, improved communication indicating the hospital’s intolerance for violent behavior, and enhanced staff training in recognizing and responding to dangerous situations. The staff training also should include “progressive behavior control methods and safe methods to apply restraints,” according to the report.

In addition to the unsafe workplace violations, the report cites a number of incidents that were inadequately reported in Acadia’s records, including several injuries that resulted in lost work time.

In a statement released shortly after 5:30 p.m. Tuesday, Acadia spokesman Alan Comeau said that at an informal conference to discuss the report findings, an OSHA compliance officer offered two “welcomed conclusions: first, that adequate staffing levels are being maintained and are not a reason for risk of staff injury. Second, that The Acadia Hospital restraint policy was not related to staff injuries or assaults.”

Comeau said Profitt would not be available to comment until Wednesday morning.